Quantitative and qualitative assessment on individual perception and self-care practice of refractive error in a rural community in Enugu, South East Nigeria.

Background: Globally, uncorrected refractive errors have been identified as the most common cause of visual impairment and the second leading cause of treatable blindness. Aim: This study quantitatively and qualitatively assessed individual perception and self-care practice of refractive error (RE) in a rural community in Enugu State. Subjects and Methods: A descriptive, cross-sectional, population-based survey was done in Amorji community, Enugu State. A pretested, researcher-administered questionnaire was used to interview the respondents on knowledge of causes, features and treatment of RE, their self-care practices, and attitudes toward RE. Focus group discussions (FGDs) and in-depth interviews (IDIs) were also carried out to qualitatively assess these parameters. Data was analyzed using SPSS version 20. Results: A total of 522 adults, 307 (58.8%) males, and 215 (41.2%) females aged 43 ± 31.6 (range 18-83) years participated in the study. Of the participants, 235 (45.0%) had good knowledge of RE; 272 (52.1%) had positive attitude toward RE, while only 51 (9.8%) had good self-care practice. Educational status was significantly (p = 0.02) associated with participants' knowledge, attitude, and self-care practices. Good knowledge significantly (p = 0.001) influenced attitude and self-care practices among the participants. Results from FGDs and IDIs were in agreement with those obtained from the questionnaire-based part of the study. Conclusion: The participants from Amorji community had good knowledge of the features of RE but poor knowledge of its causes and treatment. They also exhibited positive attitude, but poor self-care practices toward refractive errors.

EFFECTIVENESS OF TEACHERS IN THE DETECTION OF EYE DISORDERS AMONG PRIMARY SCHOOL CHILDREN IN ABAKALIKI METROPOLIS, EBONYI STATE NIGERIA.

Background: Schoolteachers who have knowledge on eye diseases can detect early children with eye disorders and refer them promptly to an eye specialist. The aim of this study is to assess the effectiveness of teachers in a vision screening program for primary school children in Abakaliki. Methods: This descriptive cross-sectional study was conducted among 20 randomly selected primary schoolteachers in Abakaliki to screen for vision abnormalities and detect eye problems among 350 children from 5 schools. Teachers participated in a 2-day training using a modified training algorithm on vision screening using a Snellen's chart and in the identification of common ocular abnormalities. Data was analysed using IBM SPSS version 26 statistical program and a p-value of <0.05 at 95% confidence level was statistically significant. Results: A total of 379 children were enrolled into the study however, 350 (92.3%) children participated in the study. School teachers correctly identified 283 (92.8%) children who had normal vision and 33(73.3%) who had impaired vision. Overall 60 (17.1%) children with perceived eye defects were referred to the ophthalmologist for re-examination. Refractive error and allergic conjunctivitis were the most common eye problems identified and children with refractive error and other ocular morbidity were referred to the base hospital. Conclusion: Teachers are a valuable resource in the detection of eye disorders among school children. Their effectiveness can be further enhanced by regular training, and collaboration with eye care professionals. Addressing these limitations through policy implementation can lead to better eye health outcomes for school children in Nigeria.

Posture-induced intraocular pressure changes among patients with primary open angle glaucoma in a Nigerian Tertiary Hospital: Any implication for management.

Background and Aim: To determine the effect of postural changes on intraocular pressure (IOP) among newly diagnosed patients with primary open-angle glaucoma (POAG). Patients and Methods: This was a cross-sectional observational study of 55 consecutive newly diagnosed patients with POAG attending Glaucoma clinics at a Federal Teaching Hospital in Abakaliki, Ebonyi state, from July to September 2017. Patients IOPs were measured in the sitting position, supine without a pillow, and supine with pillow positions using Perkin's handheld applanation tonometer. All data were analyzed with SPSS version 20.0. Results: A total of 55 subjects were recruited comprising 30 (54.5%) males and 25 (45.5%) females, with a mean age of 50.13 ± 9.97 years and an age range of 30-79 years. The mean intraocular pressure was 27.54 ± 3.98 mmHg in the sitting position, 30.15 ± 4.41 mmHg in the supine with pillow position, and 35.22 ± 4.61 mmHg in the supine without pillow position. The mean difference of mean IOP of sitting compared to supine without the pillow was 7.68 ± 2.08 mmHg (P-value < 0.001, 95% CI: 7.12-8.24); sitting compared to supine with the pillow was 2.61 ± 1.49 mmHg (P-value < 0.001, 95% CI: 3.01-2.21), whereas supine without the pillow compared to supine with the pillow was 5.07 ± 2.24 mmHg (P-value 0.001, 95% CI: 4.47-5.68). Conclusion: IOP was lowest in the sitting position and highest in the supine without pillow position. There was a statistically significant reduction in IOP on the assumption of supine with pillow position compared to supine without pillow position. The use of thick pillows in supine positions (such as during sleep or relaxations) rather than lying supine without pillows may reduce IOP spikes in POAG patients. This may have a positive effect as regards treatment and progression of glaucoma.

Determinants of Eye Care Utilization in Rural South-eastern Nigeria.

To determine the barriers and incentives to eye care utilization (ECU) in Abagana, a rural south-eastern Nigerian community. The study was a population-based cross-sectional mixed method (quantitative and qualitative) survey of adult inhabitants of Abagana, in July-August, 2011. Data on respondents' socio-demographics, barriers and incentives to ECU were collected, and analysed using descriptive and comparative statistics. A p < 0.05 was considered statistically significant. Qualitative data were obtained from focus group discussions and in-depth interviews and analyzed using ATLAS.ti software. The 549 respondents (males 224) were aged 49.8 ± 15.9 SD years (range 18-93 years). Overall, orthodox eye care had ever been sought by 42.4%, and 46.4% of those who reported change in vision. Lack of awareness-31.8%, cost-18.0%, and fatalistic attitudes-15.9% were the main ECU barriers. Possession of health insurance (OR 11.49; 95% CI 4.21-31.34; p = 0.001), family history of eye disorder (OR 3.27, 95% CI 2.03-5.26; p = 0.001), noticed change in vision (OR 11.30; 95% CI 1.42-90.09; p = 0.022), current eye disease (OR 4.06; 95% CI 2.29-7.19; p = 0.001) and systemic co-morbidity (OR 4.33; 95% CI 2.67-7.02; p = 0.001) were the incentives to ECU. To enhance the low ECU in Abagana community, educational interventions on eye health maintenance and eye health seeking behaviours, and measures to reduce eye care cost are recommended.

Eliminating the barriers to uptake of cataract surgery in a resource-poor setting: a focus on direct surgical cost.

BACKGROUND: Cataract remains a leading cause of blindness worldwide. Despite the high therapeutic efficacy of cataract surgical interventions, surgical uptake has been sub-optimal, especially in low- and middle-income countries. OBJECTIVE: The objective was to investigate the effect of surgical fee reduction on the uptake of cataract surgical services at the University of Nigeria Teaching Hospital (UNTH) Enugu. METHODS: In a retrospective comparative study, all patients who underwent cataract surgery at UNTH between January 2008 and December 2011 were identified from the eye theatre's surgical logbook. Their clinical charts were recalled and relevant demographic and clinical data were abstracted, categorized into pre (January 2008 to December 2009, Group A), and post (January 2010 to December 2011, Group B) surgical fee reduction groups. Descriptive and comparative statistical analyses were performed. RESULTS: A total of 376 cataract surgeries (Group A, 164 [43.6%]; Group B, 212 [56.4%]) was performed during the 4-year study period. The surgeries were performed on 217 males, and 159 females aged 55.4 ΁ 23.4 standard deviation years (range, 7 months to 89 years). The average annual uptake of cataract surgery was 94 overall, 82 pre and 106 postsurgical fee reductions. The two groups did not differ significantly by age (P = 0.8750) or gender (P = 0.8337). CONCLUSION: There is low uptake of cataract surgery at UNTH Enugu. Direct surgical fee reduction alone caused only a modest increase in uptake without alteration in age and gender balance. Further fee reduction and exploration of other uptake barriers are warranted.

Knowledge and attitudes towards eye diseases in a rural south-eastern Nigerian population.

BACKGROUND: Knowledge and attitudes concerning eye disorders are important socio-demographic parameters critical for eye care uptake and outcomes, especially in underserved populations. OBJECTIVES: To assess knowledge and attitudes concerning common eye disorders in a rural south-eastern Nigerian population. METHODS: The study was a population-based survey of knowledge and attitudes concerning common eye diseases conducted in Abagana community in September 2011. RESULTS: The participants comprised 263 males and 238 females. Their profile of good knowledge was eye infections: 38.9%; refractive error: 28.9%; cataracts: 18.0%; diabetic retinopathy: 8.0%; glaucoma: 5.8%; and overall good knowledge: 4.0%. Prevention and treatment of eye disorders were rated as first priorities over other major disabilities by 91.4% participants. Older age and formal education were the significant predictors of good knowledge. CONCLUSION: In Abagana, there is poor overall and disorder-specific knowledge of eye disorders. Socio-demographic factors are important determinants of knowledge. Community-based preventive eye health education is underscored.

The knowledge and attitude of non-ophthalmic medical doctors towards glaucoma in two tertiary institutions in south eastern Nigeria.

AIMS AND OBJECTIVES: This study is aimed at determining how much knowledge of glaucoma the non-ophthalmic medical doctors still possess and their personal attitudes toward glaucoma. PATIENTS AND METHODS: Self- administered questionnaires were randomly distributed to the non-ophthalmic medical doctors in two specialist hospitals in south eastern Nigeria: The data obtained were the age, sex, professional and number of years of practice of the participants, their knowledge of the symptoms/ aetiology/risk factors, examination/investigation, treatment of glaucoma as well as their personal attitude towards glaucoma. RESULTS: There were two hundred respondents; one hundred and forty two males and fifty eight females (M:F=2.4:1); comprising 82.5% Resident doctors; 51% of whom had been in practice for less than 5 years.All the doctors had heard of glaucoma; approximately seventy two per cent (72.5%) had a good knowledge of glaucoma symptoms and 52.0% of these had been in practice for only 5 years or less. Similarly, of the 83% of the doctors who correctly answered the questions on the aetiology of glaucoma, majority (84.3%) had been in practice for 5 years or less. Only 24.5% and 38.5% respectively of the doctors had a good knowledge of the basic examination and treatment required for the management of glaucoma.There was no statistically significant relationship between most variables tested. Only the relationship between the knowledge of the symptoms of glaucoma and the duration of practice of the doctors was statistically significant (p< 0.005). CONCLUSION: Most of the non-ophthalmic medical doctors have a basic knowledge of glaucoma and how to investigate it but showed a poor knowledge of examination and treatment modalities. They also acknowledged the importance of regular eye checks but only very few had had their eyes examined.

Short term results of pterygium surgery with adjunctive amniotic membrane graft.

OBJECTIVE: The objective of this study is to present the 3 months results of pterygium excision with adjunctive amniotic membrane graft. MATERIALS AND METHODS: In a non-comparative case series study, the medical records of all patients who had pterygium excision with adjunctive amniotic membrane transplant on bare sclera from December 2009 to August 2010 were reviewed. All the patients were followed up for 3 months. The data collected were sex, age, occupation, type of pterygium (primary or recurrent), extent of pterygium, post-operative complications and recurrent pterygium growth. RESULTS: Thirty eyes of 30 consecutive patients were operated on. There were 14 males and 16 females (M:F =1:1); age range 25 to 70 years (mean: 48.3 SD + 12.01). Twenty-six eyes had primary and 4 recurrent pterygia. Stage 3 pterygium accounted for most of the cases (53.3%) followed by stage 2 (36.7%) and stage 4 (10%). Nineteen patients (63.3%) had occupations with considerable exposure to actinic damage. Of these, manual laborers accounted for the highest number contributing 13 (43.3%) out of the 19 cases. Of the 30 patients 2 had a reoccurrence giving a recurrence rate of 6%. One patient developed dellen 1 week post-operatively with complete resolution following conservative large soft contact lens application. CONCLUSION: Short term results suggests that adjunctive amniotic membrane transplant with pterygium excision is effective and safe. A larger randomized clinical trial with a longer follow-up period is however recommended.

Pterygium: A review of clinical features and surgical treatment.

BACKGROUND: Ptergium is a frequently encountered clinical entity in ophthalmic practice. Although commoner in the tropics compared with the temperate region, all Ophthalmologists worldwide should be conversant with the clinical features and outcome of various approaches to surgical management. A review of the efficacy of the currently available surgical procedures for pterygium excision using postoperative recurrences as the main outcome measure is presented. METHOD: Manual and electronic (PUBMED, MEDLINE, AJOL AND HINARI) search for medical literature relevant to clinical features and surgical treatment of pterygium was conducted. Previous reviews, large case series reports, randomized controlled trials and one meta-analysis were selected and critically reviewed. RESULTS: Postoperative recurrence is a dominant complication of pterygium excision irrespective of the adopted surgical procedure. Pterygium excision with adjunctive therapy and ocular surface reconstruction is the current procedure of choice in view of its comparatively higher efficacy in preventing recurrence. CONCLUSION: Recurrence is the commonest postoperative complication of pterygium excision. There is need for further research into the aetiopathogenesis and risk factors for recurrence of human pterygia.

Orbito-ocular neoplasms in Enugu, South-Eastern, Nigeria.

BACKGROUND: Orbito-ocular neoplasms are important causes of ophthalmic morbidity and mortality. Various reports have shown that they occur more commonly among Africans than Caucasians. In this era of HIV pandemic, an increase in the frequency of AIDS-related orbito-ocular neoplasms has also been reported. OBJECTIVE: This study was carried out to determine the pattern of orbito-ocular tumours in Enugu, South-Eastern Nigeria and to compare it with the findings from earlier studies in the same area, other parts of Nigeria and other countries. METHODS: In a retrospective, non-comparative case series study the records of all the cases of orbito-ocular neoplasms seen in the Histopathology departments of the two tertiary multidisciplinary hospitals with major eye clinics in Enugu (ParkLane Specialist and University of Nigeria Teaching Hospitals) between January 2001 and August 2005 were analysed for types of tumours, frequency of occurrence, sex and age of patients. RESULTS: A total of 43 cases were analysed. There were 17 males and 26 females (M: F-l:1.4). Retinoblastoma was the most commonly occurring neoplasm accounting for 25.6% of all the tumours; followed by squamous cell carcinoma of the conjunctiva which was seen in 5 (11.6%) of cases. Squamous papilloma and Burkitt's lymphoma each accounting for 9.3% of the tumours in the series were the third most commonly occurring ones. CONCLUSION: In spite of the limitations of the study our findings suggest that the spectrum of orbito-ocular neoplasms has generally remained the same in Enugu, South-Eastern Nigeria as well as in other parts of the country.

Tuberculosis and the eye.

OBJECTIVES: 1. To refresh knowledge on the epidemiology, pathogenesis, clinical features, investigations and treatment of ocular tuberculosis; 2. To highlight the ocular complication of tuberculosis. METHOD: Through an internet search and review of current literature on tuberculosis and its ocular complications, the information relevant to the objectives was obtained. CONCLUSIONS: TB can affect any structure in the eye and adnexae. Ocular TB is not easy to diagnose because most times there is no concurrent active systemic tuberculosis. However, once TB is confirmed, treatment is generally the same as for systemic TB. Topical steroids are given in addition, in cases like phlyctenulosis. Early diagnosis and treatment of ocular TB can prevent blindness or severe ocular morbidity. With the growing epidemic of HIV and the consequent increased risk of developing TB, ophthalmologist and eye care workers are, therefore, advised to heighten their suspicion of ocular TB.

Types of Glaucoma and recent trends applied in treatment: Observations from a Glaucoma Training Workshop in the Gambia.

OBJECTIVES: To determine types of glaucoma seen and the recent trends applied in treatment, a retrospective non-comparative case-series study was conducted in the Eye Unit of the Royal Victoria Hospital, Banjul, The Gambia. METHODS: The records of the 88 patients(145 eyes) seen during the glaucoma training workshop(organised by Prof.James Standefer, a clinical ophthalmologist from Minneapolis, U.S.A.) which held between 3rd and 14th of September, 2001, were analysed for types of glaucoma and treatment given. All but one patient who was a baby underwent the following tests: visual acuity measurement using the illiterate E-Chart with multiple optotypes; tonometry using the Schiotz tonometer with the 5.5g weight; oblique flashlight test; Van Herrick's estimation of the angle depth; pupillary reactions to light; Slitlamp biomicroscopy; gonioscopy using the 4-mirror pressure gonioprism; fundoscopy using the +78D Volk lens and confrontational visual field analysis. RESULTS: 27 eyes did not have definite glaucoma. Out of the remaining 118 eyes, 65(55.08%) had POAG;17(14.41%)ACG out of which 8 were CACG and 2 acute ACG. 8 eyes had pseudoexfoliation of the lens capsule with or without glaucoma. In the frail and elderly, guttae Timoptol 0.5% was given once daily. 27 eyes had trabeculectomy; all were with releasable sutures and intraoperative application of 5-Fluorouracil. 3 eyes had laser trabeculoplasty and 5, diode laser transscleral cyclophotocoagulation. CONCLUSIONS: POAG was the commonest type of glaucoma seen. Pseudoexfoliation of the lens capsule with or without glaucoma and ACG are not very rare in The Gambia. In the frail and elderly, guttae Timoptol 0.5% was given once daily and none at all in painless glaucoma-blind eyes. Trabeculectomy with releasable sutures and intraoperative application of 5-FU has a very satisfactory pressure-lowering effect. KEYWORDS: glaucoma; treatment; the Gambia.

Congenital eye anomalies in Enugu, South-Eastern Nigeria.

OBJECTIVES: To determine the types of congenital ocular anomalies seen in the eye clinic of the University of Nigeria Teaching Hospital Enugu, over an 8-year period from January 1992 to December 1999. METHOD: In a retrospective non-comparative case-series study, the records of all patients with congenital ocular anomalies seen between January 1992 and December 1999, were analysed for types of anomalies, aetiology, sex and ages at presentation of all patients. RESULTS: A total of 54 cases were analysed: 25 females; 29 males (M:F = 1: 1.2). Congenital cataract was the most frequently occurring congenital ocular anomaly (42.6%); followed by congenital glaucoma (22.2%) and anophthalmia/microphthalmia and congenital esotropia (9.3%) each. CONCLUSION: In spite of the limitations of this study our findings are similar to those in other studies.

Refractive errors among students of a postprimary institution in a rural community in south-eastern Nigeria.

OBJECTIVE: To determine the prevalence and types of refractive errors seen among students of Girls' Secondary School, Akegbe Ugwu in Nkanu West Local Government area of Enugu State, Nigeria. METHODS: A questionnaire documented the students' personal data, their chief complaints and past ocular history. This was followed by unaided visual acuity assessment then assessment with pinhole, anterior segment examination, fundoscopy, non-cycloplegic objective and subjective refraction in those found to have an unaided visual acuity of less than 6/9 in either eye and improved vision with pinhole. RESULTS: A total of 355 students aged 12 -21 years was tested. Out of these, 9 (2.53%) had uncorrected vision worse than 6/9 in either or both eyes. Uncorrected refractive error accounted for the reduced vision in 7 cases 5 of which were myopia. CONCLUSION: There is a prevalence of refractive error of 1.97 % among students of this rural girls' secondary school in South-Eastern Nigeria. The low prevalence of myopia (1.4%) found agrees with the report that, though the most common refractive cause of visual impairment globally, it is relatively rarer in Africans.